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The operating framework for the NHS has now been published. Reading through the detail I was struck by the tasks laid at the door of PCT clusters. These transitional organisations know the date of their death. Despite that, there is an expectation they will continue to deliver, whilst acting as a catalyst for the reforms: go to paragraph 3.7, paragraphs 3.18 and 3.21, paragraphs 3.22 and 3.24 (and help me understand what the rules around that last paragraph are?). Paragraph 3.25 has enormous implications. More work is detailed in paragraphs 4.36 & 4.37, and so on.

Anyone who has worked in a commissioning organisation will instantly grasp the scale and complexity of work entailed in what is being asked of PCT clusters through 2012/13. Holding the irreconcilable tension of continuing to be accountable and being performance managed rigorously by strategic health authorities, whilst enabling the CCGs to develop, flourish, and ready themselves for the job in 2013, feels stretching, to say the least.

I have met with two arms of the SHA in the last week or so. One arm is focussed on system performance and delivery; the other on reform and transition to the new world. Both were explicit in their expectations. This fits with the statement in the operating framework:
“..there should be no trade off between delivering ongoing performance and supporting and facilitating the development of new and emerging organisations and clinical leadership for commissioning.”( Paragraph 3.5).

This is completely understandable, desirable, and necessary. However, in April of this year I let go of the staff, which I had left, to our clinical commissioning groups (CCGs), after we had made the required management reductions. They were accompanied by some of the PCT Directors. Despite that, the CCGs feel they don’t have enough staff – and they are right. The trouble is, in some of the other directorates there aren’t enough people to give to each CCG. So we have agreed to share them through a commissioning support unit. There are not enough finance people to give each CCG their own chief financial officer. Even by sharing those people between CCGs they are utterly consumed by the work set out in operating framework. As for the contracting staff, they are overwhelmed, at what is traditionally their busiest time of year, with having to do a stock take of all provider contracts and the work required for the NHS commissioning board on the primary care contracts.

I heard the discontent emerging from the recent NHS Alliance conference and can empathise with the frustrations expressed. Somehow, PCT clusters have to work with their colleagues in CCGs to square the circle. This will depend on relationships, mutual understanding, and accepting that we all have a duty to ensure that patient care is not impaired by the challenges which the reforms and the economy have imposed upon the NHS. Demonising either side will not help.

It will be critical for the SHAs and CCGs to support and keep the staff in PCT clusters motivated through 2012/13 – whilst they are hanged, drawn, and quartered.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

It certainly is asking a tremendous amount of already hard-pressed and shrinking organisations! Perhaps it makes the case even stronger for partnerships being the one essential foundation through transition? If Clusters and CCGs embraced the symbiosis of their relationship, collaborative priority setting, programme planning and job shadowing might help both to learn-while-doing.